Provider Demographics
NPI:1417904764
Name:HOLLINGSWORTH, AMBER L (PHD, CCC/SLP)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:L
Last Name:HOLLINGSWORTH
Suffix:
Gender:F
Credentials:PHD, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 COLUMNS CIR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-6376
Mailing Address - Country:US
Mailing Address - Phone:727-398-6661
Mailing Address - Fax:727-319-1209
Practice Address - Street 1:VAMC BAY PINES, AUDIOLOGY & SPEECH PATHOLOGY
Practice Address - Street 2:10000 BAY PINES BLVD
Practice Address - City:BAY PINES
Practice Address - State:FL
Practice Address - Zip Code:33744
Practice Address - Country:US
Practice Address - Phone:727-398-6661
Practice Address - Fax:727-319-1209
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6214235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist